Publication | ThinkSet, issue 6

Can California Regulations Fix Medical Provider Directory Accuracy?

Brian Hoyt

Fall 2018

Provider directories—in which insurance plans publish information about the healthcare practitioners in their networks—are taxing for everyone.

Insurers fret about compliance with regulatory requirements, which has turned into a multimillion-dollar liability for some of the nation’s biggest health plans. Doctors and hospitals field frequent faxes and phone calls from insurers seeking to verify directory information. And consumers find that the accuracy of directories often leaves much to be desired.

Now California is attempting to attack the problem by pairing the Golden State’s most dependable weapon—regulatory muscle—with clever technology. We would do well to pay attention given California’s history of leadership on consumer issues. From automobile mileage standards to medical marijuana, California has time and again set the pace for the country.

For insurers, the directories pose a daunting logistical challenge. With tens of thousands of providers practicing myriad specialties in offices across any given state, insurers often deploy a small army to keep directories current, in both online and (mandated) hard copy formats. Directories are subject to a variety of federal and state regulations, as are provider networks, which must be sufficiently robust to meet the medical needs of patients in each geographic area. And when regulators crack down, the plaintiffs’ bar typically follows, resulting in enormous restitution payments for consumers who unwittingly paid out-of-network charges for providers that were mistakenly listed in directories.

Read the full article.


Related Professionals

Brian E. Hoyt

Managing Director

Washington, DC